The 8 Best Tests To Diagnose A Hormonal Disorder (That Most Docs Don't Order)

In the latest epidemiology studies in the U.S., the prevalence of overt hypothyroidism varies from 0.1 to 2% of adults. The prevalence of subclinical hypothyroidism1 is higher, ranging from 4 to 10% of adults, with possibly a higher frequency in older women. In fact, hypothyroidism is five to eight times2 more common in women than men, and more common in women with small body sizes at birth and during childhood.

I want to highlight a point on which all the medical litera­ture agrees (both traditional endocrinologists and integrative medicine doctors): Thyroid disease is underdiagnosed4. Could it be affecting you or someone else you know with a "busy brain"? It is estimated that one in eight people have thyroid disease that is getting missed because their symptoms are not obvious. Or they are like me and their TSH levels are in the normal range despite symptoms of thyroid issues.

Thyroid disease can promote the occurrence of other symptoms of a busy brain, including insomnia and ADD/ADHD. Research shows that those with generalized resis­tance to thyroid hormones are far more likely to have ADHD5 when compared to other family members with healthy thy­roid functions. Another large meta-analysis assessed that hy­perthyroidism and hypothyroidism have clinical overlap with sleep conditions such as insomnia, restless legs syndrome, and obstructive sleep apnea6. In other words, well-established symptoms of nervousness, anxiety, and insomnia are related to both hyperthyroidism and subclinical hypothyroidism.

Too often, a thyroid disorder is missed by a physician be­cause of vague symptoms given by the patient, and only one laboratory value is checked—the thyroid-stimulating hor­mone (TSH). As a part of a routine screening, a doctor will see that your TSH is within a broad normal range from 0.4 to 4.0 mIU/L. Without a more comprehensive lab evaluation for your thyroid gland, it cannot be said that "your thyroid func­tion is normal." Too often, key symptoms—such as lack of daytime energy, and anxiety—are dismissed as "stress" with­out digging deeper to assess if the thyroid gland is the culprit.

So why aren't more people, including myself back in the day, getting their full thyroid panels screened by their phy­sicians? In my clinical days, a thyroid disorder had to show physical symptoms, such as weight gain and constipation, for a doctor to consider treatment. A primary care doctor or endocrinologist did not consider neurological and psychiatric symptoms of ADHD, anxiety, and insomnia as part of a thy­roid disorder. Suppose these are the primary symptoms you have and you do not have the physical symptoms of thyroid imbalance. In that case, clinical studies show a primary care doctor is less likely to treat your thyroid disease.

Instead, you'll hear what I did many years ago: "You are just a stressed-out type-A personality…" Sure, and by the way, when I got my full evaluation with Cenegenics hormone doctors, to no one's surprise, I had autoimmune Hashimoto's thyroiditis. Autoimmune thyroid disease can often present with a TSH in a normal range while your immune system is attacking your thyroid gland like it is a foreign invader. The doctors at the Cenegenics clinic started me on medication at age thirty-seven, and for the first time in my life, I had energy and reg­ular periods.

I try not to go back and play the if-only game, wondering what would have happened if this was caught in my 20s when I was in medical school. Would I have been less stressed? Would I have ended up with such severe acha­lasia? Would I have been able to get pregnant? How different would my life be? The what-if or if-only game is dangerous and made even worse when we have a busy brain. Now I consider that I had to journey through my mess in order to help you clean up yours.

Adapted from an excerpt of The Busy Brain Cure @ 2024 by Romie Mushtaq, LLC, used with permission by Hanover Square Press.